Blood Pressure Reduction and Secondary Stroke Prevention: A Systematic Review and Metaregression Analysis of Randomized Clinical Trials

@article{Katsanos2017BloodPR,
  title={Blood Pressure Reduction and Secondary Stroke Prevention: A Systematic Review and Metaregression Analysis of Randomized Clinical Trials},
  author={Aristeidis H. Katsanos and Angeliki G. Filippatou and Efstathios Manios and Spyridon Deftereos and John Parissis and Alexandra Frogoudaki and Agathi Rosa Vrettou and Ignatios Ikonomidis and Maria Pikilidou and Odysseas Kargiotis and Konstantinos Voumvourakis and Anne W. Alexandrov and Andrei V. Alexandrov and Georgios Tsivgoulis},
  journal={Hypertension},
  year={2017},
  volume={69},
  pages={171–179}
}
Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding… 

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References

SHOWING 1-10 OF 49 REFERENCES
Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events: A Systematic Review
TLDR
Evidence from randomized controlled trials supports the use of antihypertensive agents in lowering blood pressure for the prevention of vascular events in patients with previous stroke or transient ischemic attack.
Comparative Effectiveness of Blood Pressure-lowering Drugs in Patients who have Already Suffered From Stroke
TLDR
Evidence from RCTs supports the use of diuretics-based treatment, especially when combined with ACEI, for the secondary prevention of recurrent stroke and any vascular events in patients who have suffered from stroke.
Intensive blood pressure reduction in acute intracerebral hemorrhage
TLDR
The findings indicate that intensive BP management in patients with acute ICH is safe, and intensive BP reduction appears to be associated with a greater attenuation of absolute hematoma growth at 24 hours.
Effect of antihypertensive treatment in patients having already suffered from stroke. Gathering the evidence. The INDANA (INdividual Data ANalysis of Antihypertensive intervention trials) Project Collaborators.
TLDR
Blood pressure lowering drug interventions reduced the risk of stroke recurrence in stroke survivors, and more data are needed before considering antihypertensive therapy in normotensive patients at high cerebrovascular risk.
[Effects of blood pressure lowering treatment on stroke recurrence in patients with cerebrovascular diseases-a large-scale, randomized, placebo controlled trial].
TLDR
4 years of blood pressure lowering treatment was beneficial in Chinese patients with previous cerebrovascular diseases, and benefits were achieved similarly in all subgroups: male or female, middle-aged or elderly, with or without hypertensive, cerebral infarct or haemorrhagic stroke.
Post-stroke antihypertensive treatment study. A preliminary result.
TLDR
The findings of this trial indicate that in patients with a history of stroke or TIA, blood pressure reduction of 5/2 mmHg with 2.5 mg indapamide reduced the first incidence of fatal and nonfatal stroke by 29%, with three-year absolute benefit of 29 events per 1000 participants.
Telmisartan to prevent recurrent stroke and cardiovascular events.
TLDR
Therapy with telmisartan initiated soon after an ischemic stroke and continued for 2.5 years did not significantly lower the rate of recurrent stroke, major cardiovascular events, or diabetes.
Update on the Management of Hypertension for Secondary Stroke Prevention
TLDR
The most recent evidence on the management of hypertension in patients who have had a stroke is presented, and questions such as the choice of antihypertensive drug and by how much to reduce BP are yet to be resolved.
Lowering of Blood Pressure for Recurrent Stroke Prevention
TLDR
Some expert opinion suggests that management of high vascular risk patients with hypertension remains aggressive for now until specific compelling trial evidence is available, and the importance of optimizing recurrent stroke prevention to lessen the personal and societal burden of stroke cannot be overemphasized.
...
...